Does Immunosuppressive Therapy Improve Outcomes in Graves' Disease? A Systematic Review and Meta-Analysis

Struja, Tristan; Guebelin, Larissa; Kutz, Alexander; Fehlberg, Hannah; Müeller, Beat; Schuetz, Philipp

doi:10.1089/thy.2015.0647

Cited by 19 publications

(23 citation statements)

References 24 publications

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“…The immunosuppressive drugs for GD patients mainly included corticosteroid and noncorticosteroid drugs [25–29]. A recent meta-analysis demonstrated a strong reduction of the recurrence risk when immunosuppressive drugs were added to standard ATD treatment in GD patients, and the reduction of the recurrence risk was similar in studies using corticosteroid and noncorticosteroid immunosuppressive drugs [30]. In this meta-analysis, the overall recurrence rate in GD patients receiving the addition of immunosuppressive drugs was 23.5%, which was significantly lower than 59.1% in GD patients only treated with ATD [30].…”

Section: Treatment Strategies Of Atd and The Recurrence Riskmentioning

confidence: 99%

“…A recent meta-analysis demonstrated a strong reduction of the recurrence risk when immunosuppressive drugs were added to standard ATD treatment in GD patients, and the reduction of the recurrence risk was similar in studies using corticosteroid and noncorticosteroid immunosuppressive drugs [30]. In this meta-analysis, the overall recurrence rate in GD patients receiving the addition of immunosuppressive drugs was 23.5%, which was significantly lower than 59.1% in GD patients only treated with ATD [30]. Therefore, the addition of immunosuppressive drugs might be helpful to decrease the recurrence rate of GD patients after ATD withdrawal, whereas there are still some problems to mention.…”

Section: Treatment Strategies Of Atd and The Recurrence Riskmentioning

confidence: 99%

“…First, studies addressing immunosuppressive treatment for GD are always small, single-center, and with low to moderate quality and high risk of bias [25–29]. Second, the side effects of immunosuppressive drugs should have great importance [30]. The administration mode of immunosuppressive drug included oral and local administrations [25–29].…”

Section: Treatment Strategies Of Atd and The Recurrence Riskmentioning

confidence: 99%

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Antithyroid Drug Therapy for Graves’ Disease and Implications for Recurrence

Liu

et al. 2017

International Journal of Endocrinology

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Graves' disease (GD) is the most common cause of hyperthyroidism worldwide. Current therapeutic options for GD include antithyroid drugs (ATD), radioactive iodine, and thyroidectomy. ATD treatment is generally well accepted by patients and clinicians due to some advantages including normalizing thyroid function in a short time, hardly causing hypothyroidism, and ameliorating immune disorder while avoiding radiation exposure and invasive procedures. However, the relatively high recurrence rate is a major concern for ATD treatment, which is associated with multiple influencing factors like clinical characteristics, treatment strategies, and genetic and environmental factors. Of these influencing factors, some are modifiable but some are nonmodifiable. The recurrence risk can be reduced by adjusting the modifiable factors as much as possible. The titration regimen for 12–18 months is the optimal strategy of ATD. Levothyroxine administration after successful ATD treatment was not recommended. The addition of immunosuppressive drugs might be helpful to decrease the recurrence rate of GD patients after ATD withdrawal, whereas further studies are needed to address the safety and efficacy. This paper reviewed the current knowledge of ATD treatment and mainly focused on influencing factors for recurrence in GD patients with ATD treatment.

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Section: Treatment Strategies Of Atd and The Recurrence Riskmentioning

confidence: 99%

Section: Treatment Strategies Of Atd and The Recurrence Riskmentioning

confidence: 99%

Section: Treatment Strategies Of Atd and The Recurrence Riskmentioning

confidence: 99%

See 1 more Smart Citation

Antithyroid Drug Therapy for Graves’ Disease and Implications for Recurrence

Liu

et al. 2017

International Journal of Endocrinology

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“…The immunosuppressive drugs for GD patients mainly included corticosteroid and non corticosteroid drugs [16] A recent meta-analysis demonstrated a strong reduction of the recurrence risk when immunosuppressive drugs were added to standard ATD treatment in GD patients. In this meta-analysis, the overall recurrence rate in GD patients receiving the addition of immunosuppressive drugs was 23.5%, which was significantly lower than 59.1% in GD patients only treated with ATD [18] . Therefore, the addition of immunosuppressive drugs might be helpful to decrease the recurrence rate of GD patients after ATD withdrawal, whereas there are still some disadvantages to mention.…”

Section: Use Of Immunosuppressive Drugsmentioning

confidence: 62%

“…How-ever, the side effects should not be disregarded, no matter the mode [30] . The side effects of corticosteroids include bone abnormalities, metabolic disturbances, and muscle wasting, and rituximab was associated with leucopenia, rash, minor infections, chills, and fever [18] . Therefore, further large-scale randomized controlled trials are needed to address the safety, efficacy, optimal timing, and duration of immunosuppressive drugs in GD patients.…”

Section: Use Of Immunosuppressive Drugsmentioning

confidence: 99%

Treatment for Graves’ Disease and its Recurrence

Hussain¹

2017

JMSCR

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Methodological Quality Assessment of Meta-Analyses of Hyperthyroidism Treatment

et al. 2017

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Hyperthyroidism is a common condition that is associated with increased morbidity and mortality. A number of meta-analyses (MAs) have assessed the therapeutic measures for hyperthyroidism, including antithyroid drugs, surgery, and radioiodine, however, the methodological quality has not been evaluated. This study evaluated the methodological quality and summarized the evidence obtained from MAs of hyperthyroidism treatments for radioiodine, antithyroid drugs, and surgery. We searched the PubMed, EMBASE, Cochrane Library, Web of Science, and Chinese Biomedical Literature Database databases. Two investigators independently assessed the meta-analyses titles and abstracts for inclusion. Methodological quality was assessed using the validated AMSTAR (Assessing the Methodological Quality of Systematic Reviews) tool. A total of 26 MAs fulfilled the inclusion criteria. Based on the AMSTAR scores, the average methodological quality was 8.31, with large variability ranging from 4 to 11. The methodological quality of English meta-analyses was better than that of Chinese meta-analyses. Cochrane reviews had better methodological quality than non-Cochrane reviews due to better study selection and data extraction, the inclusion of unpublished studies, and better reporting of study characteristics. The authors did not report conflicts of interest in 53.8% meta-analyses, and 19.2% did not report the harmful effects of treatment. Publication bias was not assessed in 38.5% of meta-analyses, and 19.2% did not report the follow-up time. Large-scale assessment of methodological quality of meta-analyses of hyperthyroidism treatment highlighted methodological strengths and weaknesses. Consideration of scientific quality when formulating conclusions should be made explicit. Future meta-analyses should improve on reporting conflict of interest.

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Does Immunosuppressive Therapy Improve Outcomes in Graves' Disease? A Systematic Review and Meta-Analysis

Cited by 19 publications

References 24 publications

Antithyroid Drug Therapy for Graves’ Disease and Implications for Recurrence

Antithyroid Drug Therapy for Graves’ Disease and Implications for Recurrence

Treatment for Graves’ Disease and its Recurrence

Methodological Quality Assessment of Meta-Analyses of Hyperthyroidism Treatment

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